An up-close view of Indigenous health – good and bad

March 21, 2016

Professor Owler meets with staff at a remore community health service in the Northern Territory

By AMA President Professor Brian Owler

No running water, overcrowded and non-functional houses, lack of affordable healthy food, no essential services and crippling rates of diabetes, kidney disease and communicable infections – these are just some of the issues that people living in remote Northern Territory communities such as Utopia, Ampilatwatja and Kintore endure every day. On a recent visit to these three communities, I gained a deeper understanding of local health issues and the challenges that doctors and nurses face in delivering health services in remote areas.

In meeting with local Aboriginal leaders and health and medical staff, I found that each community has their own unique challenges; but the overall messages that I heard were strikingly similar. Funding for local health services is inadequate, it is difficult to attract skilled health and medical professionals to work in remote areas, it is logistically challenging to provide health care in remote communities (particularly when patients need to be transported for specialist care), and the level of chronic diseases in these communities are alarming.

Take diabetes, for example. In Kintore, 130 of the community’s approximately 450 residents have non-gestational diabetes – almost a third of its entire population – and in every three houses, one person is on dialysis due to the onset of kidney disease. What is even more concerning is the young age that Aboriginal people are being diagnosed with diabetes. In Utopia, a seven year-old girl was recently diagnosed with type 2 diabetes, and in Ampilatwatja, a 13 year-old girl was diagnosed with the same condition. Among the broader Australian population, or perhaps anywhere in the world, it is unheard of for child so young to be diagnosed with type 2 diabetes, yet it is clearly visible in remote Aboriginal communities.

The lack of water and affordable healthy food in remote communities is strongly linked to the epidemic levels of diabetes among Aboriginal people in these areas. Sugary drinks are more readily available than diet soft drinks, and in some communities they are more accessible than running water. It is unfathomable that in Australia, communities are going without water – a basic human right and a necessity for good health and wellbeing. This is an issue that demands immediate attention and action by all levels of government – without it, the health gap between Indigenous and non-Indigenous Australians will remain wide and intractable.

One important lesson that I did learn while visiting these communities is that it is not all doom and gloom when it comes to Indigenous health. Yes, Aboriginal people in remote areas face great adversity, but they are patient, resilient, strong-willed and are determined to take control of their own health – there are some real positives happening.

At the Purple House, an Aboriginal-controlled dialysis service based in Alice Springs, I was told an inspiring story of Aboriginal people taking action to generate funds for more dialysis sites. Kidney disease is rife across central Australia, with many Aboriginal people developing this condition as a result of poorly controlled diabetes.

The need for dialysis in remote Aboriginal communities is extremely high and for many, treatment means leaving family and country to be treated in Alice Springs. To allow people to be treated on country and near family, Aboriginal artists from across the western desert region grouped together and painted artworks that were auctioned to raise funds. The auction raised more than $1 million, and Purple House was able to expand their dialysis services. They now operate across nine remote communities in the Northern Territory and Western Australia. Purple House also provides a mobile dialysis service via their ‘Purple Truck’, which travels to remote Aboriginal communities.

It is very rare that good news stories such as this are widely publicised, which is disappointing. We need to shed more positive light on Indigenous health, and Indigenous affairs more broadly in Australia.

The POCHE Centre for Indigenous Health and Wellbeing in Alice Springs is also making a positive contribution to the health of Aboriginal people. At the POCHE Centre, I learnt about the research currently being undertaken by PhD candidate Maree Meredith, a young Aboriginal woman from Queensland. Her research project aims to determine the role that art centres play in contributing to positive health outcomes for Aboriginal people across the Anangu Pitjantjatjara Yankunytjatjara (APY) lands. To ensure that this research was in line with cultural protocols and to ensure that appropriate data was collected, Ms Meredith worked with Anangu people to design and deliver a survey in the local language.

For many years, anecdotal evidence has suggested art centres make a significant contribution towards health and wellbeing, but there has been no empirical data. This study aims to provide reliable evidence that art centres improve the health and wellbeing of Aboriginal people in remote communities. This is also a clear example of building the capacity of local Aboriginal people to participate in the local workforce.

Aboriginal people know what they want – they know the best way to improve their health and wellbeing, and this must be acknowledged and supported if we are to truly close the gap.

While in Kintore, I spoke with Aboriginal leaders who mentioned that the local people prefer a traditional social and emotional wellbeing framework to be implemented in their community, rather than a Western one.

The community developed a proposal for Government funding for this initiative, but unfortunately it was not accepted.

Connection to culture is important to the health and wellbeing of Indigenous people, and is known to produce positive health and life outcomes, such as reduced incarceration rates.

Aboriginal people needed to be provided with a reason to stay in the communities where they are connected to their land, culture and families. Recent comments made by certain members of Parliament about subsidising the ‘lifestyle choices’ of Aboriginal people in remote areas are extremely concerning.

Within each of these communities, I was disheartened to see a world-class health system fail the Aboriginal people in remote communities. But, I was truly impressed by the resilience and determination of the local Aboriginal people and the passion, commitment and dedication of doctors, nurses and other health staff who work tirelessly such challenging environments.

I am extremely grateful to Warren Snowden, Member for Lingiari, for making visits to these communities possible, and for accompanying me throughout the trip. I am hopeful that we will see further progress made in improving health and life outcomes for Indigenous people across Australia.